California lawmakers must vote by Monday on whether to keep a bill to create a universal health care system moving forward.
Monday, Jan. 31, is the last chance for California Democrats in the Assembly to keep the bill alive this year.
That bill is separate from a second bill to fund the universal health care system, which has a different deadline and doesn't have to pass on Monday.
If both bills were passed, California would become the first state to offer universal health care, but it faces strong opposition from business groups and the insurance industry, the Associated Press reported.
It would cost taxpayers at least $356.5 billion a year to cover the health costs of nearly 40 million residents, according to the latest estimate. California's total operating budget -- which pays for public schools, courts, roads and bridges and other important services -- is roughly $262 billion this year, the AP said.
Earlier this month, Democrats proposed an amendment to the state constitution that would permit new taxes on businesses and individuals that would generate about $163 billion a year to help pay for the universal health care system, and allow tax increases to cover costs as they rise, the AP reported.
"A vote for this bill is naturally a vote for the taxes that come along with it," Preston Young, a policy advocate with the California Chamber of Commerce who is leading a coalition of 130 companies against the bill, told the AP. "Health care costs continue to increase, so the tax obligations correlated with it will go up as well."
But for those who support the bill, the logic is simple: Californians and their employers are already paying far too much for health care through high deductibles, copays and monthly insurance premiums, but if the bill becomes law it would eliminate all of those and replace them with taxes.
"Sure, there is sticker shock. But there should be sticker shock for how much we are paying now," Stephanie Roberson, director of government relations for the California Nurses Association, told the AP. "What are we getting? People are still uninsured. People are still underinsured. People are going into medical debt. People have to reach tens of thousands of dollars of deductibles. We'll eliminate that under this program."
Progressives have called for a single-payer health system in the United States for years, saying it would control costs and save lives. But the concept has never come to fruition: Vermont enacted the nation's first single-payer health care system in 2011, but later abandoned it because of the cost. National proposals in Congress have gone nowhere, the AP reported.
Even in California, voters overwhelmingly rejected a single-payer system in a 1994 ballot initiative. State lawmakers tried again in the 2000s, twice passing single-payer legislation only to have both bills vetoed by then-Gov. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed the Senate but died in the Assembly, the AP reported.
On Monday, the bill needs 41 votes to survive. Democrats have 56 of the 80 seats in the Assembly, but they are missing three of their more liberal members who have recently resigned to take other jobs, the AP reported.
Importantly, a key ally has not come to the defense of the bill: Democratic Gov. Gavin Newsom campaigned for a universal health care system during his 2018 run for governor, but has focused mostly on expanding access to insurance coverage since taking office.
Newsom has said he still supports a single-payer system, with a commission he established to study the idea set to release its report later this year. But Newsom has been silent on this latest proposal ahead of Monday's deadline, the AP reported.
Visit Harvard University for more on universal health care.